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122 forms were returned. 71% were signed.

How many hours did you attend?

The average hours of attendance for the four-day seminar were 35 hours.

With 95% of responders attending for 38 or more hours.

Will you be able to use on returning to your practice: Scored as a visual analogue scale: None......................................................................All of the presented material?

Average = 6.17 cms on 10 cm scale.

Which Topics were of interest to you?

(Chosen by = Number of attendees nominating the topic out of 122 responders.)

Most attendees did not nominate topics to be covered in more depth. The topics nominated were wide ranging and included: more information on myofascial pain syndromes, and more practical demonstrations.

We invite your comments. Please be frank and honest.

Summary of reponses.

• Positive comments were received re the set-up and running of the seminar.
• The lecturers all received mostly positive comments.
• Marilyn Strauss was frequently praised for her organisational skills.
• The provision of working lunches was well appreciated by most.
• Adherence to the lecture timetable was well appreciated.
• More practical sessions were requested.
• Improved audio-visuals were appreciated by most.

This group offered a lot of feedback and suggestions.

The situation re clinical practice and demonstrations as explored in the following question: [Would you have liked more practical demonstrations? Yes = 87%] clearly requires more attention, despite the addition of 5 workshops and the majority of lectures having a practical/demonstration component. Thus despite a large increase with the practical component equal to almost 50% our participants still required more. The majority of the 18 (of 122) who stated that the seminar structure was not to their liking specified more practical training.

The most popular topic was Fibromyalgia Vs Myofascial Pain (99) followed by Trigger Point Identification 95, Myofascial pain Overview (90) and Trigger Points-Acupuncture links (90

The least attractive topics were the Panel Discussion and Pressure Algometry.

The figures for the workshops are misleading as all but one were limited to a small number of attendees by the size of the rooms.

The improved audio-visuals: Very large screen 12' X 9', video projection of speakers and demonstrations, active Power Point presentations, multiple microphones and 3 audio-visual support technicians, were appreciated with an increase in approval from 45% to 88%.

38 hours tuition over four days is arduous but well tolerated and rewarding re knowledge acquisition in the main. The inevitable fatigue was well modified by the provision of lunches and substantial morning and afternoon teas. The provision of seminar notes for the core topics also allowed our attendees to listen rather than note take and this also helped to modify fatigue. The provision of detailed notes also allowed attendees to preview the seminars core material prior to the lectures and thereby gain a better and more easily gained understanding and rapid assimilation of complex material.

The results of this evaluation suggest that Medical Pain Education

needs to institute the following changes.

Increase the amount of clinical practice/practical demonstrations.
(This has been addressed by the instigation of a Workshop-Course 1998

Abstracted from an unsolicited 4 page letter received from an attendee at Medical Pain Education's 1997 Myofascial Pain Management Seminar

"Since the myofascial pain management conference my eyes have been opened and I've seen myofascial problems wherever I've looked!. Thinking back now, my reason for attending was a vague desire to see if there was anything else I could do to treat some patients with muscle problems that wouldn't go away (the pain, nor the patients with the pain!). As I traveled home from the seminar I started recalling a number of patients I had seen who in retrospect had been suffering from myofascial problems. The bull necked council worker with severe vertigo and vomiting, the lady with "atypical facial pain" who had seen every specialist in the book and had had every x-ray and scan possible, the young lass with scapula and upper shoulder pain..........

So the lights were really turning on in my head as I came away from the seminar. And sure enough, come Monday morning there was a patient with a 'copybook' description of Sternocleidomastoid symptoms! I had seen him a few weeks earlier and had sent him away with some Stemetil but he was no better.

Now I started seeing myofascial pain, everywhere I looked!-in several patients a day. Some were new presentations, in others I reviewed what I'd seen and thought about their problems they had presented with in the past, and now I saw them with different eyes...I also began to realise that those pains had become chronic in some people because they had not been correctly diagnosed and treated at the time, and that they were continuing to suffer-not only pain but inability to work etc. How different things might have been if they had been treated right at the time.. How much suffering and disability might have been averted?

Now, I see my GP career taking an unexpected turn, because I can't ignore what I see with my "new" eyes, and there is so much to see in everyday GP presentations. And there seems to be so few people out there trained to see and treat these problems.

• That General Practice presenting/initial pain consultations involve the use of pain identification/evaluation tools including Visual Analogue Scales, McGill Pain Questionnaires and Pain Diagrams.
• That specific myofascial pain syndrome identification be attempted, when present.
• Where appropriate; that Local Anaesthetic diagnostic blocks be used to confirm the myofascial pain diagnosis and that specific myofascial pain treatment be carried out in house.

Measurement of the GP's actual clinical performance against the standards set was achieved by participating GP's filling out an audit form*, for presenting pain consultations. (*developed in conjunction with the RACGP designed to evaluate clinical performance re the above guidelines. See Attachment A. ) After the trial period the participants were asked to analyse their audits [Attachment B] and then send their audit forms for analysis by Medical Pain Education. This analysis was carried out using Access and Excel and give's both the individuals and the groups average for the usage of pain diagnostic tools, identification of myofascial pain syndromes and in house treatment rates. As well as referral rates investigation rates and script generation rates.

The results are presented below.
15 completed the activity both before and after attendance at the Myofascial Pain Management seminar (September 1997 ANA hotel Gold Coast). 23 in total carried out the activity pre-attendance and 24 post attendance. The total number of participants was 34. The total number of initial pain consultations analyzed was 452.

Table 1. Pre-attendance (Number = 23) Column 2

Post-attendance (Number = 24) Column 3

% change Column 4

NB na = question not asked

Discussion

The learning objectives for the Myofascial Pain Management seminar. was to provide the attendees with:

The 'learning objectives' of the seminar was to equip the attendees with the following;

1. A broad understanding of the Myofascial Pain concept.
1. The ability to understand and utilise the currently available tools for the measurement and quantification of Myofascial Pain Syndromes.
1. The ability to understand and utilise Myofascial Pain Syndrome's therapeutic management modalities in a safe efficacious manner consistent with western medical standards.

The Standards for the PAIN MANAGEMENT Practice Assessment Activity were:

That General Practice presenting/initial pain consultations involve the use of pain identification tools including Visual Analogue Scales, McGill Pain Questionnaires and Pain Diagrams.

That specific myofascial pain syndrome identification be attempted, when present.

Where appropriate; that Local Anaesthetic diagnostic blocks be used to confirm the myofascial pain diagnosis and that specific myofascial pain treatment be carried out in house.

From the results above there is good evidence that some perhaps all of the standards for the Practice Assessment Activity were achieved.

In particular the usage of, pain identification tools for initial presenting pain consultations, including Visual Analogue Scales increased from 18% to 80% ( an increase of 61.5%) McGill Pain Questionnaires from 0% to 57% (an increase of 57%) ) and Pain Diagrams from 16.7% to 83.5% (an increase of 67%). See graph A

That, "specific myofascial pain syndrome identification was attempted when present", is harder to assess. However the majority of myofascial pain syndromes are readily recognised when the above mentioned "Pain Assessment Tools", especially Pain Diagrams (83.5%) are used in conjunction with physical examination-palpation (95%). Hence it seems reasonable to infer that specific myofascial pain syndrome identification was attempted.

That specific in house treatment of pain syndromes was attempted is evidenced by the low rate of referrals (Nil = 65%) and the high rate of in house treatment (Trigger point injection/block 40%, Acupuncture -20%, Re-education -31%, Dry needling 10%, Spray and stretch 13%, manipulation 18% etc.)

That specific in house treatment of myofascial pain syndromes was attempted can be assessed by inference:- Trigger point injection/block 40%,. Dry needling 10%, Spray and stretch 13

The confirmation of a "Myofascial Pain Syndrome" by local anaesthetic block (where appropriate) was performed with an overall rate of 7%. However most Trigger Point injections are carried out using local anaesthetic and hence it seems logical to include the 33% of patients who had this procedure. This would bring the % confirmation of a "Myofascial Pain Syndrome" by local anaesthetic block to 40%.

The results and preceding discussion can be used to give a "snapshot" of current pain related GP practice, pre and post attendance at a Medical Pain Education Myofascial- Pain Management Seminar.

The above report has been sent to each participating GP along with their individual results thus allowing them to readily identify their performance characteristics and modify these if needed.

Individual differences in the utilisation of pain assessment tools, referrals generated and in-house treatment were uncovered. Those exhibiting wide variations have been invited to participate in a further assessment and will be re-surveyed several months after receiving their results.(Monitoring)